在肝脏脑病的治疗中消除神话
Debbie Shawcross1, Rajiv Jalan
1Institute of Hepatology, University College London, London WC1E 6HX, UK.
Lancet (London, England)
|February 1, 2005
概括
目前肝脏脑病的治疗重点是减少氨. 然而,最近的研究质疑乳糖和蛋白质限制等降氨量策略的有效性,表明需要新的治疗方法.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 临床医学 临床医学
背景情况:
- 目前针对肝脑病的指导方针强调通过结肠为基础的策略来减少氨.
- 乳糖和减少蛋白质的饮食是旨在减少氨生成和吸收的标准治疗方法.
- 新出现的证据挑战了这些传统的氨降低干预措施在高等卫生管理中的有效性.
研究的目的:
- 批判性地评估现有的证据,以减少氨的治疗在肝脏脑病变.
- 探索超出氨的替代性和新型治疗点,用于HE.
- 突出需要在HE治疗中进行新的研究和临床试验.
主要方法:
- 随机对照试验对不可吸收的分糖的系统综述.
- 对一项随机研究的分析,该研究调查了偶发性HE的正常蛋白质饮食.
- 审查目前对氨的器官间代谢的理解.
主要成果:
- 没有足够的证据支持非可吸收的脱糖酸对肝脏脑病变的益处.
- 蛋白质限制在偶发性HE中没有有益影响;正常的蛋白质饮食是安全的.
- 小肠和脏可能是重要的氨生产者,而肌肉可以去除氨.
结论:
- 肝脏脑病的新治疗策略应侧重于器官间的氨代谢,以生产和清除为目标.
- 除了氨外的因素,如炎症,需要在HE中进一步调查.
- 对新型药物的安慰剂对照试验是必要的,并转向管理引发事件.
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